Scar revision is a skin repair surgery that attempts to reduce the presence of a scar on a given part of the body. Various surgical or medical techniques can be considered to improve the aspect of a scar (cutting out, skin grafting/transplantation, local plastic surgery, skin expansion), depending on its type (retractile, ulcerated, keloid).
- We do not use skin surgery to treat acne scars and scars as a result of burns.
- Cosmetic medicine treatments such as Laser Icon or Keybody-Skin provide satisfying results to reduce certain types of scars.
1. Types of scars
A scar is the visible part of a skin lesion. It is part of the skin healing process. A scar may be the result of trauma (injury) or surgery, for example following an incision. All skin lesions cause scarring, except when the trauma is superficial and only affects the epidermis.
Various non-surgical techniques exist for partial or near-complete removal of a scar (chemical peel, laser, tattoo, ointment, infiltration, etc.). These can give great results on certain types of scars. PRX-T33 biorevitalising peel can effectively reduce newest depressed scars (acne, varicella or impetigo scars, superficial traumatic scars, post-surgical scars).
Cutaneous surgery is particularly recommended for the treatment of scars regarded as unsightly because of their width, color or irregular aspect. A surgical treatment is appropriate for scars presenting the following problems:
- Retractile scars: These scars are "curled up" due to the narrowing of the cicatricial zone, which causes some traction on the cutaneous tissues. They form slightly elevated rigid fibrous cords compared to the normal level of the surrounding skin. This type of scar is often unsightly and can sometimes lead to discomfort when moving certain parts of the body.
- Ulcerated scars: These are particularly fragile scars which can be subject to superficial abrasions that may widen and worsen over time.
- Hypertrophic or keloid scars: These are inflammatory scars, usually painful, with a very pronounced relief and a red color. Unlike hypertrophic scars, keloid scars tend to evolve after wound healing.
In general, skin surgery can correct all scars considered unsightly because of their width, color, lack of regular aspect, or causing pain.
2. Principles of the procedure
It is necessary for the scar to be mature and stable before undertaking a surgical removal.
The choice of technique will depend on the characteristics of the scar to be revised and the properties of the patient's tissues.
Two steps will be necessary for simplest cases: the initial scar will first be excised, then a new suture will be performed to obtain a more discreet scar.
In many cases, the procedure uses a special incision, a process designed to "break" the main axis of the initial scar. The scar is then reoriented according to the lines of natural tensions of the skin so as to reduce the tensions exerted on the wound.
For very large scars, several techniques can be used or combined to get the best possible result:
- Iterative excision, which consists of performing the excision of the defective scar in several steps in order to allow for the skin to relax.
- Cutaneous tissue graft taken from another part of the body
- Local ulcer to move a flap of skin around the scar to cover it Skin expansion by placing inflatable balloons under the healthy skin adjacent to the scar. These balloons are regularly inflated so as to gradually distend. After a few weeks, when the excess skin is sufficient, the skin thus obtained is used to cover the scar area.
- Lipostructure or lipofilling of the scar by injection of fat cells, to reduce or fill a depression under the scar and improve the texture of the skin next to the scar.
3. Aftermath of surgery
Surgical scar revision is usually performed under local anesthesia.
Depending on the type of scars treated, the procedure can be performed in the surgeon's office or during an outpatient hospital care.
The after-effects of surgical scar revision are usually simple and not painful. A few hours after the procedure, a slightly red and yellow oozing may be observed. A small edema (swelling) and bruise may also appear.
After the procedure, it is normal to notice some discomfort as well as some tension in the area of the scar revision. Disabling pain is very rare (if such pain occurs, consult the surgeon).
During the first days after the operation, it is important to avoid movements that may cause tension on the operated scar.
Feeling itchiness in the treated area is a common consequence of this type of procedure.
As long as the scar remains dark, it is crucial to avoid sun exposure entirely and use proper sun protection if exposure cannot be avoided.
The final aspect of the scar can only be judged after several months, sometimes up to two years. During the healing period, it is important to regularly check the progress of the scar to identify any healing disorders and apply appropriate treatment.
In most cases, significant improvement in the quality of the scar after surgical treatment is observed. But it is important to understand that healing involves a random factor depending on the patient. The quality of healing may vary depending on age, quality of tissues and the area involved. Despite the level of technical mastery of a trained plastic surgeon used to this type of procedure, the healing process remains an unpredictable and uncontrollable phenomenon.